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Rural WI Hospitals Improving Together. Overview of the surgical care improvement and stroke collaboratives. Dana Richardson, RN, MHA Vice President, Quality 608-274-1820 [email protected] Collaborative Method.

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Rural WI Hospitals Improving Together

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Rural WI Hospitals Improving Together

Overview of the surgical care improvement and stroke collaboratives

Dana Richardson, RN, MHA

Vice President, Quality


[email protected]

Collaborative Method

  • Multi-professional teams commit to improve services within a specific subject and to share how they made their improvement with others

  • Focused on a clinical or administrative subject

  • Gap between best and current practice

  • Learn from experts about the evidence for improvement, change concepts and practical changes

  • Use small changes in quick succession

  • Set measureable targets and collect data to track performance

  • Meet at least twice to share experiences

  • Participate in a continuous exchange of ideas via visits, e-mail or conference calls

Surgical Care Improvement Project (SCIP)

  • The SCIP project national goal is to “reduce preventable surgical morbidity and mortality by 25% by 2010”

  • National leadership provided by CMS and IHI

    • Evidence based guidelines

    • Consensus measures

  • Funding provided by WI Office of Rural Health, Flex Grant Program

  • Lead by Wisconsin Hospital Association

Why Surgical Care Improvement?

  • National and state interest

  • 30 million major operations per year in the U.S.

  • Known variation in perioperative care, despite major advances in surgical and anesthesia technique

  • Evidence based interventions are available to prevent complications

  • Surgical site infection (SSI) is one of the more common HAI

  • Patients with post-op complications have:

    • Increased length of stay

    • Increased mortality

    • Increased costs

  • CMS includes SSI in list of non-payment DRG’s

Hospital Profits

Source: IHI Clinical Advisory Board interview & analysis

4 Target Areas

  • Surgical infection prevention **

    • Appropriate timing and use of antibiotics

    • Appropriate hair removal

    • Postoperative glucose control

    • Postoperative normothermia

  • Cardiovascular complication prevention **

    • Beta blockers for patients on beta blockers prior to admission

  • Venous thromboembolism prevention **

    • Venous prophylaxis ordered

    • Venous prophylaxis received

  • Respiratory complication prevention (ventilator pts.)

    • HOB elevated

    • Stress ulcer prophylaxis

    • Ventilator weaning protocol

      ** Target area included in Rural SCIP Project

Project Goals

  • Engage rural hospitals in:

    • a structured shared learning project

    • objective decision making

    • team development

  • Support process change implementation related to surgical care

  • Educate rural hospitals regarding the connection between nationally recognized quality indicators and process improvement within the hospital setting

Participating Hospitals

  • Amery Regional Medical Center, Amery

  • Baldwin Area Medical Center, Baldwin

  • Boscobel Area Health Care, Boscobel

  • Columbus Community Hospital, Columbus

  • Good Samaritan Health Center, Merrill

  • Grant Regional Health Center, Lancaster

  • Hayward Area Memorial Hospital, Hayward

  • Hudson Hospital, Hudson

  • Langlade Memorial Hospital, Antigo

  • Memorial Hospital of Lafayette Co., Darlington

  • Memorial Medical Center, Ashland

  • Memorial Medical Center, Neillsville

  • Reedsburg Area Medical Center, Reedsburg

  • Ripon Medical Center, Ripon

  • Sacred Heart-St. Mary’s Hospital, Rhinelander

  • Sauk Prairie Memorial Hospital, Prairie du Sac

  • Southwest Health Center, Platteville

  • Spooner Health System, Spooner

  • Tomah Memorial Hospital, Tomah

  • Waupun Memorial Hospital, Waupun

  • Westfields Hospital, New Richmond


  • Monthly data collection

    • Excel data collection tool

    • Monthly data aggregation by WHA

  • Planning conference call with participating hospitals

  • 3 full day learning sessions (February, April, June)

  • Conference calls

  • Provided research and best practices

  • Respond to questions

Results - Measures

Results - Measures


  • National leadership through American Heart/Stroke Association

    • Evidence based guidelines

    • Data collection tool

    • Consensus measures

  • State leadership through WI Stroke Committee & the WI Heart Disease & Stroke Prevention Program

    • Approx. 25 TJC Certified Primary Stroke Centers in WI

  • Funding provided by WI Office of Rural Health, Flex Grant Program

  • Co-lead by American Heart Association & Wisconsin Hospital Association


  • Engage rural hospitals in:

    • a structured shared learning project

    • objective decision making

    • team development

  • Support process improvement change using evidence-based guidelines

  • Engage rural/critical access hospitals to use the quality data collected to monitor the progress of process improvement activities

Participating Hospitals

  • Agnesian HealthCare – Fond du Lac

  • Black River Memorial Hospital – Black River Falls

  • Bond Health Center – Oconto

  • Community Memorial Hospital Inc. – Oconto Falls

  • Divine Savior Healthcare – Portage

  • Fort HealthCare – Fort Atkinson

  • Good Samaritan Health Center – Merrill

  • Grant Regional Health Center – Lancaster

  • Langlade Memorial Hospital – Antigo

  • Memorial Hospital of Lafayette County – Darlington

  • Memorial Medical Center – Neillsville

  • Moundview Memorial Hospital & Clinic Inc. – Friendship

  • Riverview Hospital Association – Wisconsin Rapids

  • Sacred Heart-St. Mary’s Hospital – Rhinelander

  • Spooner Health System – Spooner

  • St. Joseph’s Hospital – Hillsboro

  • Stoughton Hospital – Stoughton

  • Waupon Hospital – Waupon

  • Westfields Hospital – New Richmond

  • Train on GWTG patient management tool

    • 1 year GWTG patient management tool fee paid by grant for participating hospitals

  • Two full day learning session (Jan., June)

  • Conference calls (Dec., Feb., May)

  • 7 additional Webinars during the project hosted by GWTG

Key Learning Areas

  • Overview of Brain Attack Coalition Recommendations

  • Overview of Stroke Systems of Care

  • Understanding of Stroke Consensus Measures

  • Understanding of ASA Guidelines

  • Understanding of NIH Stroke Scale

  • Focus on stroke education

  • Focus on transfer protocols

  • Focus on strategies to overcome barriers

Were the goals of the project met for your hospital?

Lessons Learned

  • Barriers to Improvement

    • Data collection

      • Infrastructure

      • Low volume

    • Reduced access to time or expertise in identifying evidence and tools available

    • One key “nay sayer” can be a huge stumbling block

  • Advantages with Improvement

    • Issues are similar to other rural (and urban) hospitals

    • Less structure so they can make changes quicker

    • A good champion can move mountains

  • Rural hospitals want and can provide “state of the science” care in their communities

Is there a role for practice based research in collaborative improvement projects?

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